Provider Demographics
NPI:1558832089
Name:SANFORD, REBECCA J (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:SANFORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 S BARRE RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-8107
Mailing Address - Country:US
Mailing Address - Phone:802-479-0432
Mailing Address - Fax:
Practice Address - Street 1:115B MONKTON RD
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-9778
Practice Address - Country:US
Practice Address - Phone:802-877-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0088214183500000X
NH3797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist